Role of Baralgin (Metamizole) in Treating Acute Gastroenteritis
Baralgin (metamizole) is not recommended for the treatment of acute gastroenteritis as there is no evidence supporting its effectiveness in reducing diarrhea volume or duration, and it may shift focus away from appropriate rehydration therapy, which is the cornerstone of treatment. 1
Appropriate Management of Acute Gastroenteritis
Rehydration Therapy - First Line Treatment
- Oral rehydration solution (ORS) is the first-line treatment for mild to moderate dehydration in both children and adults with acute gastroenteritis 2
- Evaluation of hydration status should be done through clinical signs including skin turgor, mental status, mucous membrane moisture, capillary refill, and vital signs 2
- For mild to moderate dehydration, ORS should be used until clinical dehydration is corrected 2
- Intravenous rehydration should be reserved for patients with severe dehydration, shock, altered mental status, failure of oral rehydration therapy, or ileus 2
Nutritional Management
- Continue breastfeeding in infants throughout the diarrheal episode 2
- Resume age-appropriate diet during or immediately after rehydration rather than using restrictive diets 2
- Avoid foods high in simple sugars (soft drinks, undiluted apple juice) which can exacerbate diarrhea through osmotic effects 1
Pharmacological Management in Acute Gastroenteritis
Antiemetics
- Ondansetron may be given to children >4 years and adolescents to facilitate oral rehydration when vomiting is significant 2, 3
- Ondansetron has been shown to enhance compliance with oral rehydration therapy and decrease hospitalization rates 4
- Antiemetics should only be used as ancillary treatment after adequate hydration is achieved in adults 3
Antimotility and Other Agents
- The use of nonspecific antidiarrheal agents such as adsorbents, antimotility agents, antisecretory drugs, or toxin binders is not recommended as they do not demonstrate effectiveness in reducing diarrhea volume or duration 1
- Loperamide should not be given to children <18 years with acute diarrhea 2
- Side effects of these drugs include opiate-induced ileus, drowsiness, nausea, and binding of nutrients and other drugs 1
Antimicrobial Therapy
- Antimicrobial agents have limited usefulness in the management of acute gastroenteritis since viral agents are the predominant cause 1
- Antimicrobial therapy should be considered only in specific cases such as bloody diarrhea, recent antibiotic use, exposure to certain pathogens, recent foreign travel, or immunodeficiency 1
Common Pitfalls to Avoid
- Delaying rehydration therapy while awaiting diagnostic testing is not recommended 2
- Using inappropriate fluids like apple juice or sports drinks as primary rehydration solutions for moderate to severe dehydration 2
- Administering antimotility drugs to children or in cases of bloody diarrhea 2
- Unnecessarily restricting diet during or after rehydration 2
- Reliance on antidiarrheal agents shifts the therapeutic focus away from appropriate fluid, electrolyte, and nutritional therapy 1
Special Considerations
- Probiotics may reduce symptom severity and duration in both adults and children 2
- Zinc supplementation reduces diarrhea duration in children 6 months to 5 years of age in areas with high zinc deficiency prevalence 2
- Proper hand hygiene and infection control measures are essential to prevent spread of gastroenteritis 2